"Working together to tailor opportunities for higher reimbursement around patient-centered improvements in care quality, safety and satisfaction is a shared goal between Aetna and North Shore-LIJ," said Glenn Pomerantz, M.D., Aetna Northeast Region medical director. "These multi-year agreements, which we have developed together, reflect our shared purpose of encouraging and rewarding the consistent use of the best practices in medical care." 

The selected measures are intended to achieve the following objectives:

• Member care that is effective and efficient;
• Member care that meets clinical quality standards and results in quality of care and outcome improvements for members; and
• Care practices that promote patient safety.

 "We think this is a good first step to partner with a payer to achieve higher quality of care.  The key to good business arrangements between a payer and provider is to achieve better health care for our patients.  We are pleased that Aetna recognized this as a way for our two organizations to work together," said Howard Gold, Senior Vice President of Managed Care and Business Development at North Shore-LIJ.

 The three agreements, which provide an opportunity to earn a total of $3.6 million, include the following components:

1.)  A ten-hospital Pay-for-Performance Program that is specific to care delivered to Aetna members in our commercial products.  The first year of this two-year agreement, which begins in 2009, will be a demonstration program.  It involves incentives for the North Shore-LIJ hospitals to improve:

• Quality of Care, such as assuring surgical patients receive prophylactic antibiotics prior to surgical incision;
• Efficiency, such as reducing hospital readmissions for the same injury or illness; and
• Patient Safety, such as reporting to The Leapfrog Group on individual hospital performance.

2.) A second Pay-for-Performance Program that is specific to the North Shore-LIJ   Faculty Practice treating members within Aetna's commercial, employer-sponsored or individual health benefits products. This three-year agreement provides incentives for:

• Clinical effectiveness, such as increasing screening rates for breast, cervical and colorectal cancer as well as improvement in specified diabetes screening and management measures;
• Member Experience, such as maintaining 100% access to all primary care physicians for new Aetna patients; and
• Efficiency, such as improving compliance levels with Aetna's drug formulary.

3.)  The third Pay-for-Performance program is specific to the North Shore-LIJ Faculty Practice treating members who have an Aetna Medicare plan. This program includes dedicated patient management staff from Aetna who will support the North Shore-LIJ care teams to help improve care quality for these patients, and provide incentives to the Faculty Practice for:

• Providing and documenting follow-up care for seniors with chronic medical conditions as outlined by the government's risk adjustment system; and 
• Meeting quality targets, such as assuring follow-up care at the doctor's office soon after going home after a hospital stay.

About NSLIJ 
The nation's third largest, non-profit, secular healthcare system, the North Shore-LIJ Health System cares for people of all ages throughout Long Island, Queens and Staten Island - a service area encompassing more than five million people. The health system consists of 15 hospitals, 17 long-term care facilities, The Feinstein Institute for Medical Research, five trauma centers, five home health agencies, a hospice network and dozens of outpatient centers. In addition, North Shore-LIJ is partnering with Hofstra University to develop a new medical school. Excluding its affiliate organizations, North Shore-LIJ facilities house 4,844 beds, have more than 7,000 physicians, and employ about 9,150 nurses and a total workforce of about 33,250 -- the largest employer on Long Island and the ninth largest in New York City.  For more information, go to www.northshorelij.com.

About Aetna
Aetna is one of the leading diversified health care benefits companies in the United States, serving approximately 37.2 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units and government-sponsored plans in the U.S. and internationally. www.aetna.com